人工膝关节中胫骨髓内柄的结构设计  

Structural design of tibial intramedullary stem of artificial knee joint

作　　者：曹雪坤 董万鹏[1] 董跃福 张震 张吉超 李佳意 苏德君 马洪浩 Cao Xuekun;Dong Wanpeng;Dong Yuefu;Zhang Zhen;Zhang Jichao;Li Jiayi;Su Dejun;Ma Honghao(School of Materials Science and Engineering,Shanghai University of Engineering Science,Shanghai 201620,China;Lianyungang Hospital Affiliated to Xuzhou Medical University,Lianyungang 222061,Jiangsu Province,China)

机构地区：[1]上海工程技术大学材料科学与工程学院,上海市201620 [2]徐州医科大学附属连云港医院,江苏省连云港市222061

出　　处：《中国组织工程研究》2024年第21期3326-3333,共8页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金项目(31670956),项目负责人:董跃福。

摘　　要：背景:伴随着社会进步,面对社会人口中快速发展的老龄化问题,膝骨关节炎发病率越来越高,全膝关节置换手术量逐渐增加。目的:通过对胫骨假体基座进行改进,研究假体尺寸与应力遮挡间的关系。方法:选择1例患有重度膝骨关节炎的女性患者,以Mimics为基础,通过提取膝关节骨骼结构模拟全膝关节置换手术,进行截骨、定位、置入操作,建立全膝关节置换假体(包含股骨假体、胫骨托、胫骨衬垫)的几何模型,对胫骨假体基座进行改进设计,分析不同胫骨假体基座对周围骨组织应力遮挡的影响。结果与结论:①与单柄胫骨髓内柄假体相比,四桩胫骨髓内柄假体设计在短桩周围会造成一定的应力遮挡,但是与较粗大的单个长柄相比,这种应力遮挡作用明显减小,并由4个短桩来均匀分担负荷,因而在桩底部不会造成应力集中;②中部有矩形孔的设计,不仅能提供相对好的稳定性,并且在一定程度上还有利于减少松质骨的应力遮挡,减少率达77.5%;③与单柄胫骨髓内柄假体相比,四桩胫骨髓内柄假体和中部有孔的四桩胫骨髓内柄假体都有很好的稳定性,可以在一定程度上减少应力遮挡,不会造成应力集中,为胫骨髓内柄的设计提供理论指导。BACKGROUND:With social progress,the incidence rate of knee osteoarthritis is getting higher and higher in the face of the rapidly developing aging problem in the social population,and the number of total knee replacement operations is gradually increasing.OBJECTIVE:To study the relationship between prosthesis size and stress shielding by improving the tibial prosthesis base.METHODS:A female patient with severe knee osteoarthritis was selected.Based on Mimics,through extracting the bone structure of the knee joint and simulating the total knee replacement surgery,osteotomy,positioning,and implantation operations were carried out to establish the geometric modeling of the total knee replacement prosthesis(including the femoral prosthesis,tibial bracket,and tibial pad),and improve the design of the tibial prosthesis base,analyze the effect of different tibial prosthesis bases on stress shielding of surrounding bone tissue.RESULTS AND CONCLUSION:(1)Compared with single-stem tibial intramedullary stem prosthesis,the design of four-post tibial intramedullary stem prosthesis created a certain degree of stress shielding around the short stem.However,compared with a thicker single long stem,this stress shielding effect was significantly reduced,and the load was evenly distributed among the four short stems,so there was no stress concentration at the bottom of the pile.(2)The design with a rectangular hole in the middle not only provided relatively good stability,but also helped to reduce stress shielding of cancellous bone to a certain extent,with a reduction rate of 77.5%.(3)Compared with a single-stem tibial intramedullary stem prosthesis,both the four-post tibial intramedullary stem prosthesis and the four-post tibial intramedullary stem prosthesis with a hole in the middle have good stability,which can reduce stress shielding to a certain extent without causing stress concentration,providing theoretical guidance for the design of the tibial intramedullary stem.

关 键 词：结构设计 膝关节 胫骨基座 数值模拟 假体设计 应力遮挡 人工关节 胫骨髓内柄 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] O242.21[理学—计算数学]